Form Ct-1041 Ext - Application For Extension Of Time To File Connecticut Income Tax Return For Trusts And Estates - 2016

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Department of Revenue Services
Form CT-1041 EXT
2016
State of Connecticut
Application for Extension of Time to File
(Rev. 12/16)
Connecticut Income Tax Return for
1041EXT 1216W 01 9999
Trusts and Estates
Name and Address
Read the instructions on reverse before completing this application. Complete this form in blue or black ink only. Type or print.
Name of trust or estate
Federal Employer ID Number (FEIN)
Name and title of fi duciary
Address of fi duciary (number and street), apartment number, PO Box
Decedent’s Social Security Number: estates only
City, town, or post offi ce
State
ZIP code
For DRS
Use Only
M M - D D - Y Y Y Y
Visit the Department of Revenue Services (DRS) Taxpayer Service Center (TSC)
Electronically fi le
website at to electronically fi le your return and to make a direct
Form CT-1041 EXT
tax payment or to download and print the return.
This is not an extension of time to pay your tax. You must include payment of any tax due or penalty and interest may apply. See instructions. However, if you expect
to owe no additional Connecticut income tax for the 2016 taxable year, after taking into account any Connecticut income tax withheld or estimated Connecticut income
tax payments you made, or both, and you requested an extension of time to fi le your 2016 federal income tax return, you are not required to fi le Form CT-1041 EXT.
I request a fi ve and a half-month extension of time to September 30, 2017, to fi le my Connecticut income tax return for
trusts and estates for calendar year 2016, or until
for fi scal year
(MM-DD-YYYY)
ending
.
(MM-DD-YYYY)
I have requested a federal extension on federal Form 7004, Application for Automatic Extension of Time to
Check
File Certain Business Income Tax, Information, and Other Returns, for calendar year 2016 or fi scal year
here
beginning
and ending
. If you have not
(MM-DD-YYYY)
(MM-DD-YYYY)
fi led for a federal extension explain why you are requesting the Connecticut extension:
You will be notifi ed only if your extension request is denied.
1. Total Connecticut income tax liability for 2016: You may estimate this amount.
.00
An amount must be entered on Line 1. If you do not expect to owe income tax, enter “0.” .... 1.
.00
2. Connecticut income tax withheld. ......................................................................................... 2.
3. 2016 estimated Connecticut income tax payments including any
.00
2015 overpayments applied to 2016. ................................................................................... 3.
.00
4. Add Line 2 and Line 3. . ......................................................................................................... 4.
5. Connecticut income tax: Subtract Line 4 from Line 1. Pay in full with this form.
.00
If Line 4 is greater than Line 1, enter “0.” Amount due with this form: ..........................
5.
Declaration: I declare under the penalty of law that I have examined this return and, to the best of my knowledge and belief, it is true, complete, and correct. I
understand the penalty for willfully delivering a false return or document to the Department of Revenue Services (DRS) is a fi ne of not more than $5,000, imprisonment
for not more than fi ve years, or both. The declaration of a paid preparer other than the taxpayer is based on all information of which the preparer has any knowledge.
Signature of fi duciary or offi cer representing fi duciary
Date
Telephone number
(MM-DD-YYYY)
Sign Here
Keep a
Paid preparer’s signature
Date
Preparer’s SSN or PTIN
(MM-DD-YYYY)
copy of
this return
for your
Firm’s name and address
Firm’s FEIN
Telephone number
records.
Pay by Mail: Make check payable to Commissioner of Revenue Services.
To ensure payment is applied to your account, write the FEIN of the trust or estate and “2016 Form CT-1041 EXT” on the front
of the check. DRS may submit your check to your bank electronically.
Mail paper return and check to: Department of Revenue Services, State of Connecticut, PO Box 2934, Hartford CT 06104-2934

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